Intracranial vertebrobasilar stenosis: Angioplasty and follow-up

BACKGROUND AND PURPOSE: When medication fails to improve symptoms of athero sclerotic stenosis of the intracranial vertebral and basilar arteries, perc utaneous transluminal angioplasty (PTA) is considered. However, because inv estigators disagree on the usefulness of this procedure, we conducted a ret rospective study to evaluate the indications, efficacy, and safety of PTA. METHODS: Twenty patients underwent PTA of the vertebral (n = 14) or basilar (n = 6) artery, 18 for neurologic signs and symptoms of arterial stenosis that recurred or progressed despite pharmacotherapy and two prophylacticall y, Neurologic examinations were performed before and after the procedure an d arterial patency was evaluated at follow-up by digital subtraction angiog raphy and/or MR angiography, Imaging follow-up was available for 14 (70%) o f the 20 patients, neurologic follow-up for 15 (75%). RESULTS: The stenosis was successfully dilated in all patients, and on foll ow-up neuroradiologic examinations, vessel patency could be seen in 12 (86% ) of 14 patients. Only one (7%) of 15 patients who returned for a follow-up neurologic examination had new symptoms (caused by occlusion of the verteb ral artery 4 months after the procedure). One patient had a reversible neur ologic deficit and one had hemiparesis after PTA. No patient died as a resu lt of PTA. CONCLUSION: In our study, PTA of intracranial vertebrobasilar arteries was associated with a low mortality and morbidity rate and with a high degree o f patency, This technique may therefore be regarded as an effective means o f improving the patency of stenotic arteries. In selective cases, it might be considered for use prophylactically.